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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8493
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Hi, i was pulling on a tool today towards my face I guess when

Customer Question

was pulling on a tool today, slipped and gouged my thumbnail into the center of my open eye, It hurt terriibly and I waited for the pain to go away which it has not, it hurts when my eye is open or closed, more so closed I think and kinda feels like a grain of sand is in there which its not. I think i scratched my eyeball, im pretty sure I did. what should I do now? , about every 20 minutes or so its like something in my eye catches or something and the pain is quite great but does go away

Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

How is your vision in that eye?

Customer:

fine

Dr. Rick :

Ok.

Dr. Rick :

It sounds like you have a corneal abrasion. Could you have actually cut the "meat" of your cornea with your thumbnail? Yes.

Customer:

yes feels like that

Dr. Rick :

The only way to tell an abrasion apart from an actual cut is to see an ophthalmologist. That being said, it is more likely that you just have an abrasion and not a cut.

Customer:

and abrasion no treatment, just heal itself?

Dr. Rick :

That is correct. It usually takes about 24 to 36 hours and, as you know, it hurt a lot until then.

Dr. Rick :

Also, with this type of injury, you are at risk for the skin coming loose again. This is called recurrent corneal erosion syndrome. Here is a bit of info on this:

Dr. Rick :

Recurrent corneal erosion is a condition where, usually after some type of trauma, the epithelial layer of the cornea ("skin") no longer attaches to the underlying tissue (bowman's layer) and keeps coming loose. Think it as a piece of Velcro, with the epithelium and bowman's layer as the two strips. In recurrent corneal erosion syndrome the little "hooks" in the Velcro are broken. RCES can also be seen as a secondary result of another disorder, such as map dot fingerprint disease.

Dr. Rick :

If this starts to happen to you here is some info on what to do:

Dr. Rick :

 


Drops and ointment are the first line of treatment. The next step is the use of a bandage contact lens at night along with the natural tears. This helps to prevent the epithelium from sticking to the inside of the eyelid, although just taking out the contact can cause an erosion. The next step in treatment is anterior stromal puncture. This is where the ophthalmologist uses a bent 25 gage needle and makes little punctures in the cornea. This is thought to help by allowing the hemidesmosomes (Velcro hooks) to attach better. I would not recommend this if the erosion is in the center of the visual axis as it can leave a small scar.


The next step in treatment is phototherapeutic keratectomy with a laser (PTK). This is the same laser used in Lasik, but used in a different way. In PTK the epithelium is removed from the cornea and the laser is used to remove part of the cells in the corneal stroma. It is thought to work by stimulating the natural regrowth of cells such that these new cells can better attach to the epithelium and prevent RCES.


Here is an excellent article on this condition that you might find helpful:


http://emedicine.medscape.com/article/1195183-overview

Dr. Rick :

I am not saying that this WILL happen, only that it could......

Customer:

ok , maybe ill just sleep for a day so my eyelids stop rubbing it. thank you much for your time and the info

Dr. Rick :

For now, try to keep your eye closed as much as possible and you can use some bland, sterile ointment such as lacrilube or refresh PM to goop up your eye.

Dr. Rick :

My pleasure. I hope you feel better soon :)

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8493
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.

I think you covered all areas of possibility and im comfortable waiting a day or 2 to see if it improves.. I am well informed now thank you

Expert:  Dr. Rick replied 1 year ago.
It is my pleasure.

Try to rest and have a good day.

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5447 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest